After James' escape from the vault, Andy is assigned to be the vault's new doctor. In one notable surgical operation, Andy decides to treat Beatrice's sprained big toe by amputating the whole leg. In performing the operation, Andy removes the wrong leg and inadvertently kills Beatrice. Andy is then reassigned as a cleaner and his first job involves cleaning up the bloody mess he made of Beatrice. When accessing the Overseer's terminal it is revealed Andy was made the doctor with the Overseer knowing he would likely do a bad job in order to demoralize the Rebels.